SPECT/CT in the Assessment of the Jaw Autograft Viability

Abstract

Purpose: To evaluate the effectiveness of SPECT/CT for the assessment of graft viability following revascularized bone grafts in patients with mandibular (18) and maxilla (1) reconstruction. 
 Material and methods: We investigated 19 patients with revascularized grafts from the fibula (16 patients), iliac crest (2 patients) and shoulder blade graft (1). For the follow up of all these patients, 99mTc-MDP bone scintigraphy and SPECT/CT was performed between 4–5 days postoperatively. The evaluation of the grafts was based on a comparison of tracer uptake between graft and the cranium.
 Results: 17 of 19 grafts had an uncomplicated clinical course. Complications in the graft occurred in two patients. In the analysis of planar scintigrams with uncomplicated healing were showed correct assessment in 10 of 17 patients and in 1of 2 patients with signs of necrosis of graft fragments. SPECT/CT was performed in addition to planar imaging.
 The increased uptake grafts were showed with SPECT/CT in all patients with uncomplicated clinical course. In the failed 2 grafts, decreased uptake was observed in both patients. In the analysis of SPECT/CT images the correct results were showed in all clinical cases.
 Conclusion: SPECT/CT performed within 6 days after the mandibular reconstruction is a useful tool to monitor the viability and early complications of revascularized mandibular and maxilla bone grafts. SPECT/CT is also recommended to interpretation of the bone scans and to precise assessment of graft viability.